Baxter, ADVATE Antihemophilic Factor (Recombinant)

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1 Baxter, ADVATE Antihemophilic Factor (Recombinant) ADVATE, Recombinant Antihemophilic Factor, is indicated for the prevention and control of bleeding episodes in people with hemophilia A (classical hemophilia). ADVATE is also indicated for perioperative management of patients with hemophilia A. ADVATE is made without the addition of human or animal blood-derived components. ADVATE is available as a lyophilized powder in single-use vials containing nominally 250, 500, 1000, 1500, 2000 and 3000 IU. The powder is reconstituted with 5 ml Sterile Water for Injection. The small infusion volume allows patients to administer their therapy conveniently and quickly. In addition, while ADVATE should be refrigerated between 2-8 C it can be stored for up to six months at room temperature, or up to the expiration date, which ever comes first. It is packaged with a 10mL syringe, a BAXJECT II Needleless Transfer Device and one Terumo Microbore Infusion set. Contraindications to the use of Advate: Known hypersensitivity to mouse or hamster proteins Known intolerance or allergic reaction to any of the constituents in the formulation of Advate Side Effects: The serious adverse drug reactions (ADRs) seen with ADVATE are hypersensitivity reactions and the development of high-titer inhibitors necessitating alternative treatments to Factor VIII. The most common ADRs observed in clinical trials (frequency 10% of subjects) were pyrexia, headache, cough, nasopharyngitis, vomiting, arthralgia, and limb injury. Management of Adverse Effects: Side Effects Flushing Headache Nausea Itching and redness at the venipuncture site Action Slow rate of infusion Potential Allergic Reaction Stuffy nose Hives/severe itching Cough Chest pain Wheezing Facial swelling Fainting Action STOP infusion immediately and contact physician Product monograph available at:

2 BAXTER: ADVATE (Recombinant FVIII) STEP 1 Bring ADVATE to room temperature before using. Choose a clean, dry, well-lit work area and lay out the following supplies: Contained in Smaller Box Bottle(s) of factor VIII powder- check dose & expiry date Bottle (s) of sterile water BAXJECT II device (s) Contained in Larger Box 1 10 ml sterile syringe 1 butterfly infusion set (#25 gauge) 2 adhesive bandages Packaged Separately (2) Alcohol swabs STEP 2 Wash hands Use warm running water Use antibacterial soap from pump dispenser Dry hands with a paper towel Turn off taps with paper towel & discard STEP 3 Remove the caps from the bottle(s) of FVIII powder and sterile water. STEP 4 Clean the tops of the bottles with an alcohol swab. Allow to dry completely. DO NOT blow on the tops to speed up drying, this will contaminate them. Place the vials on a flat surface.

3 STEP 5 Open the BAXJECT II device package by peeling away the lid without touching the inside of the package. DO NOT REMOVE DEVICE FROM PACKAGE. STEP 6 Turn the package with the device upside down over the top of the bottle of sterile water. Press down the clear plastic spike of the BAXJECT II device into the center of the bottle of sterile water keeping the bottle of sterile water on a hard surface. Grip the package at its edge and pull it off the device. DO NOT REMOVE BLUE CAP. DO NOT TOUCH WHITE SPIKE. STEP 7 Quickly invert device with the water vial attached to the BAXJECT II device (white side down) and place on top of the bottle containing the factor, press down until the white spike pierces through the center of the rubber stopper. The vacuum will draw the sterile water into the bottle of factor. STEP 8 Swirl gently to dissolve the product. IT IS ACCEPTABLE FOR A SMALL AMOUNT OF WATER TO BE LEFT BEHIND. IF THE WATER DOES NOT TRANSFER SUCCESSFULLY, PLEASE REFER TO THE TROUBLESHOOTING GUIDE. STOP HERE: Go to Step 13 if prescribed dose requires more than one vial.

4 STEP 9 Remove the blue cap from the BAXJECT II device. Connect the syringe to the BAXJECT II device. DO NOT INJECT AIR. STEP 10 Turn the system over so that the bottle with the factor solution is on top. Withdraw all the factor solution by pulling slowly on the plunger. IF YOU FIND IT IMPOSSIBLE TO WITHDRAW SOME OR ALL OF THE MIXED PRODUCT INTO THE SYRINGE, THERE MAY BE AIR IN THE DEVICE. PLEASE REFER TO THE TROUBLESHOOTING GUIDE. STEP 11 Disconnect the syringe leaving the BAXJECT II device connected. Attach the butterfly needle for peripheral vein infusion. Holding the syringe and the needle pointing up, gently flick the syringe to move any air bubbles to the top and gently push on the plunger to remove the air. DO NOT push any factor solution out of the syringe. Peripheral Vein STEP 12 Attach a blunt cannula for PORT infusion Mark the syringe with a piece of tape if using PORT. Port

5 MULTIVIAL DOSE STEP 13 Mix all product vials, using a new BAXJECT II device for each vial, as directed in Step 1 8 to prepare the prescribed dose to the nearest vial. Select a syringe large enough to hold the prescribed dose. STEP 14 Follow Step 9 10 to draw the product from each vial into the larger syringe. DO NOT INJECT AIR. Go to Step 10 for administration using a butterfly infusion set or Step 11 for administration through an established peripheral IV or Port-a- Cath. Administer the dose of ADVATE by bolus infusion over a period of < 5 minutes (maximum infusion rate, 10 ml/min). See for Troubleshooting Information

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